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Biomedical subjects

A T Young

Publications and source records attributed to A T Young.

At least 37 records · Page 2Linked to original sources
PubMed1986

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi.

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.

Humans↗
PubMed1986

Surface shield: device to reduce personnel radiation exposure.

A simple device is described that can reduce personnel exposure from scatter radiation by up to 75%. The device consists of an oblong piece of shielding (0.75-mm lead equivalent) that is taped to the side of the patient during percutaneous renal stone removal and other interventional procedures. Contrary to other shields and barriers, this does not interfere with access to the patient. Scatter exposure data from phantom studies are presented and the rationale for surface shielding discussed.

Humans↗
PubMed1985

Percutaneous management of ureteral calculi facilitated by retrograde flushing with carbon dioxide or diluted radiopaque dye.

Of 356 patients in whom percutaneous nephrostomy was performed at this institution 59 had ureteral stones. In our experience with the first 36 patients antegrade techniques for ureteral stone extraction had many assets but sometimes they were difficult. Recently, we incorporated a retrograde flushing technique, using carbon dioxide and diluted radiopaque dye, into our percutaneous approach to ureteral stones. Based on our experience with this technique in the next 23 consecutive patients, we believe that percutaneous nephrostolithotomy and retrograde flushing should be added to the armamentarium of urologists committed to the percutaneous endourological approach to ureteral stones.

Carbon Dioxide↗
PubMed1985

Changing patient populations: considerations for service delivery.

In keeping with a social work concern that pervades all fields of practice, social workers in health settings have always striven to respond to patients' individual needs. As the nature and needs of the populations that are social work's clientele change, so will the focus of the profession's efforts in delivering health care services.

Adolescent↗
PubMed1985

Percutaneous extraction of urinary calculi: use of the intercostal approach.

The authors achieved successful percutaneous extraction of urinary calculi via an intercostal approach in 24 patients. In one patient, a large hydrothorax developed and thoracentesis was required; 2 patients had moderate and 6 minimal pleural fluid collections which did not require treatment. No patient had pneumothorax. Intercostal puncture provides direct access to the upper and middle poles of the kidney when they lie above the twelfth rib and subcostal angulation is not feasible. Such an approach is advantageous for stones in the ureter, as well as renal stones which are inaccessible from the lower pole. Fluoroscopy should be performed when planning the puncture in order to avoid the lung, and a working sheath is recommended.

Adult↗
PubMed1985

Thrombosed synthetic hemodialysis access fistulas: failure of fibrinolytic therapy.

Seven episodes of acute thrombosis occurring in five patients with polytetrafluoroethylene dialysis fistulas were treated with local infusions of low-dose streptokinase. Bleeding from previous dialysis puncture sites necessitated stopping the infusion in six out of seven patients, although in one of these six, the graft reopened. The seventh patient had never been dialyzed through the graft and thrombolysis was achieved without incident. Surgery was avoided in only one patient. The authors contend that in these patients the risks of fibrinolytic therapy outweigh the benefits. Surgical thrombectomy, coupled with intraoperative angiography and possible angioplasty, is the preferred method of treating these patients. Venography prior to the creation of the fistula helps the surgeon avoid diseased vessels and may avert early failure of the fistula.

Adult↗
PubMed1985

Electrolysis for recanalization of urinary collecting system obstructions: a percutaneous approach.

Nine recent endourologic cases are presented that evidence percutaneous electrolysis and electrocautery as new and safe techniques for incising the urothelium. Electrolysis with balloon dilation was employed to remove stones sequestered behind infundibular and/or diverticular neck stenoses, to correct uretero-pelvic junction (UPJ) stenoses and strictures, and to recanalize a totally obstructed fibrotic UPJ.

Adult↗
PubMed1985

A new pyeloureteral drainage catheter.

We describe a new pyeloureteral drainage catheter that can be used for both genitourinary tract stenting and drainage, as well as tamponade of bleeding from the renal parenchyma or subcutaneous tissue. Primary indications for the use of this catheter and recommendations on insertion techniques are presented. With the exception of one case of minor kinking of the catheter, we have had no complications or failures with this catheter. While insertion through an unprotected tissue track is somewhat difficult, we have had good success introducing the catheter through a 24-F or larger Teflon working sheath. The catheter has excellent patient retention properties. It can be converted from external to internal drainage or vice versa simply and quickly on the ward.

Humans↗
PubMed1985

A new universal radiolucent handle.

A new universal radiolucent handle is described that permits needle placement under continuous fluoroscopic observation, while maintaining the operator's hands outside the primary beam. The handle accommodates nearly all needles used for biopsy, anesthesia, nephrostomy, cholangiography, and biliary drainage, which represents a major advantage over previously described radiolucent handles. Reduced operator-hand exposures, improved needle guidance, and quick handle release are also major advantages of the universal handle. It is inexpensive, reliable, and reusable.

Fluoroscopy↗
PubMed1985

Percutaneous removal of ureteral calculi: clinical and experimental results.

Between May 1983 and October 1984, 51 patients who had 68 ureteral stones underwent treatment at the University of Minnesota. All 68 stones were removed successfully using percutaneous techniques. The 100% success rate is a great improvement over previous results at our institution. The primary factors appear to be the development of the retrograde-flush technique, familiarity with and access to a wider range of methods, and the increasing use of the retrograde ureterorenoscope to see stones in the lower ureter. The average patient was a 45-year-old man who had no other medical problems. The average hospital stay was 6.8 days. Experimental studies with dogs indicate that injection rates of up to 30 ml/sec of contrast material through a retrograde catheter in the ureter are safe if a vent is present in the upper collecting system.

Adult↗
PubMed1985

Very stiff guide wire with a floppy tip.

Many interventional procedures, particularly dilation of tracts, require stiff guide wires with a floppy tip. Such a guide wire was specially constructed and is commercially available.

Bile Ducts↗
PubMed1985

Coaxial cancer dilator.

In cases in which the ureters or biliary tree is encased by large tumors, it may be difficult to dilate a pathway for a stent with a balloon catheter. In ten consecutive patients in whom balloon dilatation was unsuccessful, a coaxial tapered Teflon cancer dilator successfully crossed the obstruction.

Bile Duct Neoplasms↗
PubMed1985

Percutaneous nephrostolithotomy: application to staghorn calculi.

Twenty-five renal staghorn stones measuring at least 5 cm in diameter were removed percutaneously from 24 patients. Twelve patients required multiple access tracts for complete stone removal. Estimated blood loss more than 1000 ml occurred in 16 patients and temperature greater than 38.5 degrees C in 19 patients. All stones were successfully removed, with only two patients having definite residual fragments. Percutaneous nephrostolithotomy may be successfully applied to large staghorn stones. The relative roles of percutaneous therapy and extracorporeal lithotripsy remain to be determined.

Adult↗
PubMed1984

Failing arteriovenous dialysis fistulas: evaluation and treatment.

A total of 31 patients with 45 episodes of failing arteriovenous dialysis fistulas was studied. Fistula failure was usually due to venous and/or anastomotic stenosis, often in conjunction with thrombosis. Abnormalities were treated by percutaneous dilation and occasionally streptokinase infusion. Most complications and failures occurred either in patients with recently created fistulas or in those with multiple or long segment stenosis associated with thrombosis. Patients with a single nonobstructing stenosis were very successfully treated with percutaneous techniques, which are the treatment of choice for this condition.

Adult↗